Individual
KIMBERLY RANEE WITHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS, COTAL
Contact information
Practice address
1700 LEONARD ST NE, GRAND RAPIDS, MI 49505-5636
(616) 456-7243
Mailing address
1700 LEONARD ST NE, GRAND RAPIDS, MI 49505-5636
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5201005189
MI
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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